Jeffrey David Wine, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

1544 Issued in AZ

Practice address

2826 E Baseline Rd Ste 101
Mesa, AZ 85204-7282

Phone

(480) 626-8925

Fax

(480) 704-4036

NPI assigned

Oct 4, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Ohio State University - College of Optometry, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eyes on Site PLLCGroup PAC ID 3779659263, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as individual

Quality

81.74

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Eyes on Site PLLC

  • Optometrist
  • Mesa, AZ
  • NPI 1013163005
  Medicare reassignment Care Compare group NPD Authorized official
• Eyes on Site PLLC

  • Optometrist
  • Mesa, AZ
  • NPI 1053043331
  NPD Authorized official
• Nationwide Optometry P.C.

  • Optometrist
  • Phoenix, AZ
  • NPI 1073683348
  NPD (past)
• Nationwide Optometry P.C.

  • Optometrist
  • Tempe, AZ
  • NPI 1326472945
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1609962323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2826 E BASELINE RD STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852047282",
            "telephone_number": "480-626-8925",
            "fax_number": "480-704-4036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2826 E BASELINE RD STE 101",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852047282",
            "telephone_number": "480-626-8925",
            "fax_number": "480-704-4036"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINE",
        "first_name": "JEFFREY",
        "middle_name": "DAVID",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "1544",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145725",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Valerie Lee Wilson, LMT, MA, LPC
• Joseph W Winchell, DO
• Mark Winchell, PT
• Samantha Windatt, FNP
• Kristin Elizabeth Windhorst, COTA
• Jeffrey D. Wing, DDS, MS
• Marjorie Arlene Wingfield, CCC-SLP
• Wingfoot Wellness & Hormones LLC
• Rachel Beth Holt Wininger
• Kyle S Winner, PHARMD

• Optometrist in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.